Liver anatomy

LIVER

An organ in the
upper abdomen
that aids in
digestion and
remove waste
products and wornout cells from the
blood.

It is the largest solid

& glandular organ in

Location

Occupies the right hypochondrium and

the epigastrium.

May extend into the left hypochondrium.

What is the blood supply of the

liver?
Liver has a dual blood supply
1. Portal vein(75%)
2. Hepatic artery (25%).
The hepatic veins
are responsible
for drainage of
filtered blood
from the liver into
the IVC.

Liver anatomy
Liver anatomy can be described using two
different aspects

Morphological
anatomy
Functional anatomy

 Morphological
anatomy
Based on the external
appearance of the
liver
Does not show the
internal features of
vessels and biliary
ducts branching,
which are important
in hepatic surgery.

Surfaces
The liver has Five surfaces :
Anterior
Posterior
Superior
Inferior
Right

Anterior surface

Posterior surface

Superior surface

Visceral surface

 Functional anatomy
Divides the liver into
eight functionally
independent
segments.
Each segment has its
own vascular inflow,
outflow and biliary
drainage.

Significance of functional
anatomy
In order to perform segmental or
subsegmental resection of the liver,
the surgeon must know exactly which
parts of the liver are diseased so that
vascular supply and venous and biliary
drainage can be preserved.
Also because of this division into selfcontained units, each segment can be
resected without damaging those
remaining.

There are many anatomical and

functional descriptions of the liver
anatomy such as Classical
Anatomy & Bismuth's
classification.

However Couinaud
classification is the most
commonly used classification.

Couinaud classification
The Couinaud classification of liver
anatomy divides the liver into eight
functionally independent segments.
Each segment has its own vascular
inflow (hepatic artery & portal vein),
outflow (hepatic vein) and biliary
drainage.

 Right hepatic vein divides the right lobe

into anterior and posterior segments (segment

6 and 7 usually not visualized in the frontal
view)

Middle hepatic vein divides the liver into

right and left lobes (or right and left hemiliver).

This plane runs from the inferior vena cava to
the gallbladder fossa (Cantlie's line)

Left hepatic vein divides the left

lobe into a medial and lateral part.

What are liver segments??

Couinaud's numbering system
1-Caudate Lobe (posteriorly)
2-Left Superior Lateral segment
3-Left Inferior Lateral segment
4a-Left Superior Medial segment
4b-Left Inferior Medial segment
5-Right Inferior Anterior segment
6-Right Inferior Posterior
segment
7-Right Superior Posterior
segment
8-Right Superior Anterior
segment

Life-cycle of E. histolytica

 E.histolytica passes its lifecycle in one

host.
Infection is by ingestion of
contaminated water and food with
mature quadrinucleate cysts
In the SI, the cyst wall is lysed by
trypsin and a single tetranucleate
amoeba [metacyst] is liberated.
Each nucleus divides by binary fission
giving rise to eight nuclei.
Therefore, from each metacyst- eight
small amoebulae [metacystic
trophozoites] are produced. This

 Metacystic trophozoites are carried in the

faecal stream into the caecum.
They invade the mucosa and ultimately
lodge in the submucous tissue of large
intestine, where they grow and multiply by
binary fission.
During growth, E. histolytica secretes a
proteolytic enzyme of the nature of
histolysin [causes necrosis of tissue and
produces flask-shaped ulcers]
At this stage, amoebic dysentry occurs- as

 In few cases, erosion of large intestine is

extensive and trophozoites gain entry into
the radicles of portal vein.
They arecarried to the liver, where they
multiplication leads to amoebic hepatitis
and amoebic liver abscess.
From here it can spread elsewhere in the
body.
The trophozoites in the lumen of large
intestine transform into precyst and then